Doctors may prescribe oral contraceptives to regularize periods without looking for bleeding disorders or other problems, Dr. Jaffray said. “I would love to say to the parents, to the patients, to really advocate for yourself if you really think you're bleeding more than your peers.” A full evaluation is important, especially if there's any family history to consider.
The primary treatments for heavy menstrual periods are hormones — that is to say, the medications we think of as contraceptives. “Birth control pills for hormonal benefits, a patch, a ring, a shot, an implant or an I.U.D. are all options we give these girls,” Dr. Rosen said. “Our cycles are regulated by hormones, namely estrogen and progesterone, and to decrease the amount of menstrual bleeding someone has, you can use hormones, albeit synthetic hormones, to regulate the hormones your own body is making.”
Some parents have strong objections to their daughters taking hormones, Dr. Borzutzky said, for a broad range of reasons, many connected to historical experiences with hormone therapy. Some have had bad experiences themselves, others worry about possible future effects on their daughters' fertility or other complications, and some may be concerned that giving young women contraceptive medications will increase the chances of early sexual activity, though there is no evidence that this is true.
“There are very few patients in whom we cannot find a safe hormonal medication,” Dr. Borzutzky said. “We have to take each method one by one and talk about the safety, the benefits, the risks of each one and really go through what science we have — it's not perfect, but we have quite a bit of safety evidence.” In addition, girls with bleeding disorders may need hematologic medications, and anyone who is anemic will need iron.
So parents should discuss this with adolescents, Dr. Borzutzky said, “when they start their menstrual life,” and make sure that their periods are not causing them a lot of discomfort. Ask if there's anything they've stopped doing because of their periods, she suggested. “We say this all the time, try to just normalize discussion, give context, use humor — say, I know it feels funny to talk about this sometimes,” but emphasize that it's a completely normal part of life, and keep on checking in.
“Say that the pediatrician has asked me to check in two or three times a year about periods,” Dr. Rosen suggested. “Say, because this is your health, I need to ask you a few questions about what's going on with your period.”